mountain muscle said:
Renal artery stenosis doesn't sound like fun.
It's easily treated with a stent. It can cause renal failure if not detected early, and it can cause severe hypertension if it isn't identified and treated. That severe hypertension will lead to cardiac failure, stroke, etc. as the hypertension from RAS is often uncontrollable without stents to open up the renal artery again.
I never mentioned this before, but if you do not have RAS, I would ask them to check your cortisol/aldosterone levels and to check your urine catecholamines. RAS is the most common cause of malignant hypertension, but if you have episodes of headaches, sweating, chest pain, etc., then the urine catecholamines should definitely be checked to make sure you do not have a pheochromocytoma.
Blood pressure that high is more often from an identified and treatable cause.
While I was in residency, my cousin called me at work one day asking that I speak to a physician who was discharging her husband. He had been admitted with chest pain and found to have an elevated CPK (about 6,000, normal is <400) and severe hypertension (220/110) on presentation. They were discharging him on three blood pressure medicines, one of which they started in the hospital and made his blood pressure worse (it was metoprolol for what it's worth, which has a paradoxical effect in pheochromocyoma and actually makes your blood pressure increase in the majority of patients with a pheo). When I talked to the physician and told him to check his urine catecholamines, he laughed and said I was a resident who had "Ivy league syndrome" and said that it was so rare it's not worth checking. My cousin and her husband insisted on it. Guess what? He had it. After surgery to remove it, he's now doing well without any medicines at all.
I would insist that your physician check for RAS first, and if that is negative, then to check for a pheo (urinary catecholamines) and hyperaldosteronism or other endocrine disorders (aldosterone, cortisol, thyroid, etc.).